In 2005, almost 47 million Americans — including more than 8 million children
— were uninsured, and many more had inadequate insurance.

Apologists ... try to minimize the significance of these numbers. Many of the
uninsured, asserted the 2004 Economic Report of the President, “remain uninsured
as a matter of choice.”

And then you wake up. A scathing article in yesterday’s Los Angeles Times
described how insurers refuse to cover anyone with even the slightest hint of a
pre-existing condition. People have been denied insurance for reasons that range
from childhood asthma to a “past bout of jock itch.”

Some say that we can’t afford universal health care... But every other
advanced country somehow manages... Americans spend more on health care per
person than anyone else... Yet we have the highest infant mortality and close to
the lowest life expectancy of any wealthy nation. How do we do it?

Part of the answer is that our fragmented system has much higher
administrative costs than ... the rest of the advanced world. ... In addition,
insurers often refuse to pay for preventive care ... because [the] long-run
savings won’t necessarily redound to their benefit. And ... we lag far behind
... in the use of electronic medical records, which both reduce costs and save
lives by preventing many medical errors. ...

If it were up to me, we’d have a Medicare-like system for everyone, paid for
by a dedicated tax that for most people would be less than they or their
employers currently pay in insurance premiums. This would, at a stroke, cover
the uninsured, greatly reduce administrative costs and make it much easier to
work on preventive care. Such a system would leave people with the right to
choose their own doctors, and with other choices as well...

Can we get there from here? Health care reform is in the air. Democrats ...
are talking about providing health insurance to all children. John Edwards began
his presidential campaign with a call for universal health care.

And there’s real action at the state level. Inspired by the Massachusetts
plan..., politicians in other states are talking about adopting similar plans.
Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the
nation as a whole.

But now is the time to warn against plans that ...[don't take] on the
fundamental sources of our health system’s inefficiency. What’s wrong with both
the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like
Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a
backlash from the insurance industry and other players who profit from our
current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer
approach, even though he understood its merits, in favor of a complex plan that
was supposed to co-opt private insurance companies by giving them a largely
gratuitous role. And the reward for this “pragmatism” was that insurance
companies went all-out against his plan anyway, with the notorious “Harry and
Louise” ads that, yes, mocked the plan’s complexity.

Now we have another chance for fundamental health care reform. Let’s not blow
that chance with a pre-emptive surrender to the special interests.

In 2005, almost 47 million Americans — including more than 8 million children
— were uninsured, and many more had inadequate insurance.

Apologists ... try to minimize the significance of these numbers. Many of the
uninsured, asserted the 2004 Economic Report of the President, “remain uninsured
as a matter of choice.”

And then you wake up. A scathing article in yesterday’s Los Angeles Times
described how insurers refuse to cover anyone with even the slightest hint of a
pre-existing condition. People have been denied insurance for reasons that range
from childhood asthma to a “past bout of jock itch.”

Some say that we can’t afford universal health care... But every other
advanced country somehow manages... Americans spend more on health care per
person than anyone else... Yet we have the highest infant mortality and close to
the lowest life expectancy of any wealthy nation. How do we do it?

Part of the answer is that our fragmented system has much higher
administrative costs than ... the rest of the advanced world. ... In addition,
insurers often refuse to pay for preventive care ... because [the] long-run
savings won’t necessarily redound to their benefit. And ... we lag far behind
... in the use of electronic medical records, which both reduce costs and save
lives by preventing many medical errors. ...

If it were up to me, we’d have a Medicare-like system for everyone, paid for
by a dedicated tax that for most people would be less than they or their
employers currently pay in insurance premiums. This would, at a stroke, cover
the uninsured, greatly reduce administrative costs and make it much easier to
work on preventive care. Such a system would leave people with the right to
choose their own doctors, and with other choices as well...

Can we get there from here? Health care reform is in the air. Democrats ...
are talking about providing health insurance to all children. John Edwards began
his presidential campaign with a call for universal health care.

And there’s real action at the state level. Inspired by the Massachusetts
plan..., politicians in other states are talking about adopting similar plans.
Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the
nation as a whole.

But now is the time to warn against plans that ...[don't take] on the
fundamental sources of our health system’s inefficiency. What’s wrong with both
the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like
Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a
backlash from the insurance industry and other players who profit from our
current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer
approach, even though he understood its merits, in favor of a complex plan that
was supposed to co-opt private insurance companies by giving them a largely
gratuitous role. And the reward for this “pragmatism” was that insurance
companies went all-out against his plan anyway, with the notorious “Harry and
Louise” ads that, yes, mocked the plan’s complexity.

Now we have another chance for fundamental health care reform. Let’s not blow
that chance with a pre-emptive surrender to the special interests.